J Surg Ultrasound.  2021 Nov;8(2):32-36. 10.46268/jsu.2021.8.2.32.

Ultrasonographic Findings of Post-Operative Changes after Breast Cancer Surgery

• Kang B
• Park HY
• Jung JH
• Kim WW
• Chung JH
• Lee J

• KMID: 2525878
• DOI: http://doi.org/10.46268/jsu.2021.8.2.32

Abstract

An accurate understanding of ultrasound findings of post-operative changes in breast cancer would be one of the most important areas of breast cancer surveillance. This is especially true when the ultrasound is performed by breast surgeons who have in-depth knowledge of oncoplastic breast surgery as it would be easier for them to distinguish between true recurrence of breast cancer and post-operative changes. In this article, the various but typical post-operative changes in breast cancer are described. These findings would be truly helpful to breast surgeons for the detection of early recurrence and treatment of post-operative complications.

Keyword

Ultrasonography; Post-operative change; Breast cancer

Figure

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  Fig. 1 Ultrasonographicfindings after breast-conserving surgery. (A, B) A vertical shape of postoperative scar is observed from the skin to the pectoralis major muscle, which will be remained almost permanently. If any nodule is found around the scar or there is an increasing sign of blood flow, it should be confirmed by tissue biopsy due to possibility of tumor recurrence.

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  Fig. 2 Doppler imaging of breast ultrasonography in suspected nodule of local recurrence. (A) A 5 mm-sized hypoechoic nodule (yellow square) occurred near the axillary region, and showed increased blood flow on the doppler mode which indicating a proliferative lesion (confirmed as recurrent invasive cancer on histological examination). (B) A 2 cm-sized hypoechoic nodule (green squares) was identified around the postoperative scar. However, there is no evidence of increased blood flow in the doppler mode, suggesting a high possibility of non-proliferative lesions (fat necrosis was confirmed in biopsy).

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  Fig. 3 Local recurrence of breast cancer. (A) Malignant microcalcifi-cations (yellow dotted circle) on subareolar region were identified on mammography. (B) In ultrasound finding, a hypoechoic nodule with irregular margins were found at the same location. The lesion was dia-gnosed as a local recurrence of breast cancer in core needle biopsy.

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  Fig. 4 Ultrasound findings of a patient who were received left side of mastectomy for breast cancer. (A) The right side of contralateral breast is a normal breast. All of the breast structures are observed. (B) The left side of ipsilateral breast, which was removed as total mastectomy. Only the skin is remained overlying the pectoralis major muscle.

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  Fig. 5 Ultrasonographic finding of locally recurred nodule on ipsilateral chest wall. (A) On chest CT, an enhancing nodule was developed under the pectoralis major muscle, suggesting that blood flow was slightly increased. (B) Ultrasound finding of the same nodule. A 3.1 cm-sized nodule was identified under the pectoralis major muscle, showing irregular margins and hypoechoic material inside, which is strongly suspected of local recurrence (it was confirmed as invasive ductal carcinoma, recurred.).

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